Impact of an emergency medicine pharmacist on door to needle alteplase time and patient outcomes in acute ischemic stroke

Barbour, Julia; Hushen, Patricia; Newman, George C.; Vidal, J

doi:10.1016/j.ajem.2021.11.015

Cited by 10 publications

(13 citation statements)

References 14 publications

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“…Of the cluster randomized studies, one [ 26 ] was a sub-analysis of the completed study [ 25 ]. Three studies were of experimental before-and-after design [ 28 , 29 , 30 ], five were cross-sectional [ 31 , 32 , 33 , 34 , 35 ] and fourteen were cohort studies [ 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 ]. To capture the breadth of pharmacist interventions, two audit reports [ 50 , 51 ] and five conference abstracts [ 23 , 33 , 40 , 41 , 47 ] were also included for data extraction although quality assessment was not possible using standard tools.…”

Section: Resultsmentioning

confidence: 99%

“…Individual study characteristics are shown in Table 5 , Table 6 and Table 7 . Seven studies reported pharmacist interventions for primary stroke prevention [ 28 , 29 , 30 , 32 , 33 , 36 , 50 ] and twenty-four focussed on secondary stroke prevention [ 21 , 22 , 23 , 24 , 25 , 26 , 27 , 31 , 34 , 35 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 45 , 46 , 47 , 48 , 49 , 51 ].…”

Section: Resultsmentioning

confidence: 99%

“…Most studies (24 of 31) investigated the impact of pharmacist interventions for the secondary prevention of stroke. These interventions were at different stages of the patient treatment pathway and ranged from the immediate emergency treatment of stroke (i.e., at initial emergency department presentation) [ 35 , 37 , 38 , 40 , 41 , 42 , 43 , 44 , 46 , 47 , 48 ] and intermediate hospital-based post-acute phase care [ 22 , 27 , 34 , 51 ] through to long-term follow-up post-stroke in outpatient clinics [ 23 , 31 , 39 , 45 , 49 ], tertiary referral centres [ 21 ] or community care [ 24 , 25 , 26 ].…”

Section: Resultsmentioning

confidence: 99%

“…Pharmacist interventions in the emergency and acute care of patients diagnosed with stroke were described in eleven studies [ 35 , 37 , 38 , 40 , 41 , 42 , 43 , 44 , 46 , 47 , 48 ]. These were categorised as secondary prevention because appropriate acute treatment has the potential to reduce and prevent stroke recurrence.…”

Section: Resultsmentioning

confidence: 99%

“…Nine studies [ 35 , 37 , 38 , 41 , 42 , 43 , 44 , 46 , 47 ] reported the impact of pharmacist involvement in emergency stroke response teams responsible for the preparation and administration of emergency thrombolysis (e.g., intravenous recombinant tissue plasminogen activator (rtPA); alteplase). Emergency thrombolytics are high-cost drugs and involve complex patient assessment criteria and intense patient monitoring.…”

Section: Resultsmentioning

confidence: 99%

See 4 more Smart Citations

The Role of Pharmacists in Providing Pharmaceutical Care in Primary and Secondary Prevention of Stroke: A Systematic Review and Meta-Analysis

et al. 2022

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Pharmacists deliver pharmaceutical care in many different healthcare settings and are well-placed to support the prevention of stroke. However, their role and impact in this area is ill-defined. This systematic review aims to explore the pharmacists’ role in stroke prevention. Nine databases were searched for studies reporting pharmacist interventions in the management of primary and secondary ischaemic stroke prevention. Study quality was evaluated through Cochrane Risk of Bias and Joanna Briggs Institute (JBI) appraisal tools where possible. A narrative review was conducted and meta-analysis performed for studies with comparable outcomes. Of the 834 initial articles, 31 met inclusion criteria. Study designs were varied and included controlled trials, observational studies, audit reports and conference abstracts. Seven studies addressed the pharmacists’ role in primary prevention and 24 in secondary prevention. Pharmacist interventions reported were diverse and often multifactorial. Overall, 20 studies reported significant improvement in outcomes. Meta-analysis showed pharmacist interventions in emergency care significantly improved the odds of achieving thrombolytic therapy door to needle (DTN) times ≤45 min, odds ratio: 2.69 (95% confidence interval (CI): 1.95–3.72); p < 0.001. The pharmacists’ role is varied and spans the stroke treatment pathway, with the potential for a positive impact on a range of health-related outcomes.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

See 3 more Smart Citations

The Role of Pharmacists in Providing Pharmaceutical Care in Primary and Secondary Prevention of Stroke: A Systematic Review and Meta-Analysis

et al. 2022

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Advancements in the management of acute ischemic stroke: A narrative review

et al. 2023

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Primary literature detailing updated management principles of acute ischemic stroke outpaces current guidelines, resulting in heterogenous practices. Recent advancements in neuroimaging have shifted treatment from a time‐based approach to an individualized, image‐guided appraisal directed by the presence or absence of salvageable brain tissue. In addition, tenecteplase appears to be a safe and effective for the treatment of acute ischemic stroke and is becoming an attractive agent due to its practical administration. Several factors must be accounted for when implementing tenecteplase into the health‐system including cost, education, and changes in clinician workflows. Larger studies with broad patient populations are needed to more definitively evaluate whether intravenous thrombolytics should be used in combination with endovascular thrombectomy in patients with anterior large‐vessel occlusions. Although debate regarding the safety and efficacy of various endovascular therapies, delays encountered in the identification, triage, and care of acute ischemic stroke patients increase the likelihood of necrotic core lesion development and loss of salvageable penumbra.

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Survey of national practices for postgraduate year two critical care and emergency medicine pharmacy residency emergency response training

Philips

Cycz

Liu

et al. 2023

J Am Coll Clin Pharm

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IntroductionMedical emergency response within the hospital involves an interdisciplinary team, including pharmacists. Pharmacist involvement in these teams has increased over time due to published benefits of their involvement. Development of emergency response skills may start during pharmacy residency, although limited data suggest how this is best implemented.ObjectivesLimited data evaluate post‐graduate year 2 (PGY2) pharmacy resident training for emergency response, as well as PGY2 program values for this in screening/ranking candidates, which may help post‐graduate year one (PGY1) pharmacy residents identify residency programs that are a good fit for their career goals.MethodsA list of PGY2 critical care (CC) and emergency medicine (EM) programs were identified. The questionnaire included program demographics, characteristics of PGY2 emergency response training, and PGY2 residency program values of PGY1 emergency response exposure for screening and ranking applicants for their programs. A Fisher's exact test was used to compare differences between CC and EM programs for these outcomes.ResultsA total of 85 complete responses were analyzed (response rate by all identified programs: CC = 36.4%; EM = 32.1%). Emergency response training was often with both core and longitudinal experiences (72.9%), although differed by type of program (p < 0.001). Both CC and EM programs considered PGY1 pharmacy resident exposure to emergency response in screening candidates (33.9% and 57.7%, respectively), as well as ranking candidates (22% and 38.5%, respectively). For CC programs, both Advanced Cardiovascular Life Support certification and quantity of PGY1 emergency response ranked as the most important characteristics, while EM programs ranked quantity as the most important.ConclusionThe results of this survey indicate heterogeneity in PGY2 CC and EM emergency response training. PGY1 applicants for these programs should consider their experience with emergency response as a potential factor in identifying an appropriate program for their training.

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Impact of an emergency medicine pharmacist on door to needle alteplase time and patient outcomes in acute ischemic stroke

Cited by 10 publications

References 14 publications

The Role of Pharmacists in Providing Pharmaceutical Care in Primary and Secondary Prevention of Stroke: A Systematic Review and Meta-Analysis

The Role of Pharmacists in Providing Pharmaceutical Care in Primary and Secondary Prevention of Stroke: A Systematic Review and Meta-Analysis

Advancements in the management of acute ischemic stroke: A narrative review

Survey of national practices for postgraduate year two critical care and emergency medicine pharmacy residency emergency response training

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